Question:Two months ago I had a total hip replacement. I wasn't prepared for how painful it was afterwards -- worse than my arthritis. Now I'm glad I had it done but I can't help but wonder why they can't do more for patients to reduce the pain.
Pain control after major orthopedic surgery has really come a long way. General anesthesia (putting the patient to sleep) was the standard way to operate for years. But there were serious problems with blood loss and blood clots.
Over time doctors have been able to narrow the anesthesia down to the specific area being operated on. This is the use of nerve blocks called regional anesthesia. The risk of blood clots is much less. Patients are also less likely to have nausea, vomiting, fever, and breathing problems.
Postoperative pain is still a problem. The latest effort to control pain after a hip replacement is the continuous use of nerve blocks. The doctor keeps the leg from feeling any pain for hours to days after the surgery. The hope is to find a drug that will do the same thing but still allow the patient to go home.
For now, a combination of anesthesia and narcotics seems to work well. Each patient is different so it's never clear what dose of each drug is ideal. Doctors and nurses must adjust both to find the optimal treatment for each person.Pier Francesco Indelli, MD, et al. Regional Anesthesia in Hip Surgery. In Clinical Orthopaedics and Related Research. December 2005. No. 441. Pp. 250-255.
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